Uworld | Step 2ck

2022-10-27 21:46:01 Educational objective: Patients with an intracranial mass often have headache associated with nausea and vomiting andfor focal neurologic deficits. Symptoms are often worse at night and with body positioning that increases intracranial pressure. An MRI of the brain is usually diagnostic . Open / Comment

2022-10-27 08:46:01 Open / Comment

2022-10-27 08:45:12 A 65-year-old man comes to the ·office due to unsteady gait and frequent falls over the past 2 months. His left side feels "weak," which makes it difficult to maintain balance when walking or standing. He has also had headaches and nausea, which are worse in the mornings before he has had coffee. The patient has a history of hypertension and type 2 diabetes mellitus, and he had a myocardial infarction 5 years ago. He takes insulin for diabetes mellitus but does not routinely monitor his blood glucose. The patient is a former smoker and does not use alcohol or illicit drugs. Blood pressure is 130/80 mm Hg and pulse is 76/min. Ambulation results in the patient swaying to the left and using the wall to brace himself. There is increased resistance to passive flexion of the left upper and lower extremity. Open / Comment

2022-10-26 20:45:18 Educational objective: The management of myasthenic crisis with respiratory failure consists of endotracheal intubation followed by treatment with plasmapheresis (or intravenous immunoglobulins) and corticosteroids. Open / Comment

2022-10-26 08:45:13 Open / Comment

2022-10-26 08:44:01 A 68-year-old man with myasthenia gravis is evaluated for progressive weakness while hospitalized. The patient was admitted 2 days prior due to fever, productive cough, and pleuritic chest pain. Chest x-ray demonstrated a right lower lobe consolidation for which the patient has been receiving intravenous ceftriaxone and azithromycin. He also has been receiving his outpatient dose of pyridostigmine.
In the past several hours,
he has experienced progressive generalized weakness and an inability to cough out sputum. His temperature is 37.6 C (99.8 F), blood pressure is 130170 mm Hg, pulse is 11 Of min, and respiratory rate is 25fmin. Oxygen saturation is 89°/o on 4 Umin oxygen by nasal cannula. The patient appears to be in distress, and his breathing pattern is rapid and shallow with occasional gurgling sounds. Lung auscultation reveals coarse crackles throughout There is mild weakness of the extremities, but deep tendon reflexes are normal. His vital capacity is now 1.0 L compared to 1.5 Lat the time of admission, and arterial blood gas shows pH 7.27, pC02 55 mrn Hg, and p02 60 mm Hg. The patient is intubated and moved to the intensive care unit Open / Comment

2022-10-11 08:25:07 Educational objective: Vascular dementia typically presents as a sudden or stepwise decline in executive function with mild memory loss early in the disease. Patients can have focal neurologic deficits on examination, and neuroimaging classically demonstrates a cerebral infarction andlor deep white matter changes from chronic ischemia. Open / Comment

2022-10-11 08:25:07 Open / Comment

2022-10-11 08:24:02 A 74-year-old woman is brought to the office by her son. He is concerned because his mother had an unprovoked fall a year ago and has since relied on him to coordinate her activities and make decisions about everyday matters. The patient's symptoms seemed to improve until she sustained another significant fall about 6 months ago. She has also become mildly forgetful, experiences occasional mood swings, and now seems sad most of the time. The patient has a long history of hypertension, stress urinary incontinence, and depression. She has a family history of colorectal cancer and Alzheimer disease. Temperature is 36.7 C (98 F), blood pressure is 141187 mm Hg, pulse is 82fmin, and respirations are 14fmin. Neurologic examination shows weakness and sensory deficits on the right side. 11/lental status examination is significant for low volume of speech and flat affect The remainder of the examination is within normal limits. Open / Comment

2022-10-10 20:16:03 Educational objective: Lacunar strokes occur due to microatheroma formation and lipohyalinosis in the small penetrating arteries of the brain. They often affect the internal capsule and result in pure motor herniparesis. Hypertension, hyperlipidemia, diabetes, and smoking are major risk factors. Open / Comment